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. 2008 Jun;32(3):389-94.
doi: 10.1007/s00264-007-0335-8. Epub 2007 Mar 9.

A new material for prevention of peritendinous fibrotic adhesions after tendon repair: oxidised regenerated cellulose (Interceed), an absorbable adhesion barrier

A Temiz  1 , C Ozturk, A Bakunov, K Kara, T Kaleli
Affiliations

A new material for prevention of peritendinous fibrotic adhesions after tendon repair: oxidised regenerated cellulose (Interceed), an absorbable adhesion barrier

A Temiz et al. Int Orthop. 2008 Jun.

Abstract
in English, French

In this experimental study, we aimed to examine the ability of absorbable oxidised regenerated cellulose (Interceed, TC-7, Johnson & Johnson, USA) to inhibit the formation of peritendinous fibrotic adhesions after tendon repair in rats. Both Achilles tendons of 23 female Wistar-Albino rats weighing between 350 and 450 grams were cut and repaired. On the right side, Interceed absorbable adhesion barriers were wrapped around the repaired tendon (group I). On the left, the same procedures were applied except for the Interceed wrapping and these were grouped as control (group II). Animals were sacrificed at postoperative day 28 and macroscopic and histological examination was performed. All the animals survived and no tendon rupture was observed. No wound dehiscence, wound infection or exposure of repaired tendons occurred. Macroscopically, there were three (13.1%) tendons without adhesion formation and 20 (86.9%) tendons with inferior adhesion formation in group I; on the other hand, there were 16 tendons (69.5%) with medium grade adhesion formation and seven tendons (30.5%) with severe peritendinous adhesion formation in group II (control group) (p<0.05). Histologically, adhesion formation was absent in 11 tendons (47.8%) and slight in 12 tendons (52.2%) in group I; while in group II, it was slight in two (8.6%), moderate in 15 (65.2%) and severe in six tendons (26.2%) (p<0.05). Sixteen (69.5%) of 23 tendons in group I and 11 (47.8%) of 23 tendons in group II showed no inflammatory reaction (p<0.05). Nineteen (82.6%) tendons in group I and only one tendon in group II showed excellent to good tendon healing (p=0.00). According to our results, we feel that Interceed may have an intraoperative role to play in the reduction of adhesions after surgical tendon repair. This study suggests that absorbable oxidised regenerated cellulose merits further evaluation as a potential treatment to inhibit the formation of peritendinous adhesions. Rigorous and extensive controlled trials should be undertaken on patients undergoing tendon repair with or without this barrier.

Cette étude expérimentale a pour but de mettre en évidence l’action de l’Interceed TC-7 de Johnson & Johnson afin d’éliminer la formation d’adhérence péri-tendineuse dans la réparation de tendons chez le rat. Les deux tendons d’Achilles de 23 rats albinos femelles pesant entre 350 et 450 grammes ont été sectionnés puis réparés. Du côté droit, le produit Interceed a été appliqué autour du tendon (groupe I), le côté gauche a constitué le groupe contrôle. Les animaux ont été sacrifiés à J28 avec un examen macroscopique et histologique. Tous les animaux ont survécu à la réparation et aucun n’a présenté de rupture du tendon. Il n’y a pas eu d’infection. Macroscopiquement, dans le groupe I, 3 tendons (13.1%) n’ont pas présenté d’adhérence péri-tendineuse et 20 (86.9%) ont présenté des adhérences inférieures. Dans le groupe contrôle 16 rats (69.5%) présentaient des adhérences de grade moyen et 7 (30.5%) des adhérences importantes, cette différence était significative (p < 0.05). Histologiquement, la formation d’adhérences est nulle chez 11 rats (47.8%) et légère chez 12 (52.2%). Dans le groupe I, en ce qui concerne le groupe contrôle, les adhérences sont présentées chez deux rats (8.6%) sont modérées chez 15 rats (65.2%) et sévères chez 6 rats (26.2%) dans le groupe II (p < 0.05). 16 (69.5%) des 23 tendons du groupe I et II (47.8%) des 23 tendons du groupe II ne montrent pas de réaction inflammatoire (p < 0.05). 19 (82.6%) tendons du groupe I et seulement 1 tendon du groupe II montrent une excellente cicatrisation. Ces résultats démontrent que l’Interceed peut avoir un rôle important dans la réduction des adhérences après réparation chirurgicale des tendons. Après cette étude, nous pouvons penser que ce produit nécessite d’autres évaluations quant à son potentiel d’inhibition dans la formation d’adhérences péri-tendineuses.

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Figures

Fig. 1
Fig. 1
On the right side, Interceed absorbable adhesion barriers were wrapped around the repaired tendons and recorded as group I. On the left Achilles tendons, the same procedures were applied without the Interceed wrapping and they were grouped as control (group II)
Fig. 2
Fig. 2
All the rats lived for 28 days in room temperature and at the end of the first postoperative month, postoperative walking analysis was done. From this analysis, preoperative and postoperative foot sign length (PL), distance between 1st and 5th digits (TS) and distance between 2nd and 4th digits (IT) were measured
Fig. 3
Fig. 3
Macroscopic appearance of healed tendons. a Experiment group. b Control group
Fig. 4
Fig. 4
Histological examination showed minimal peritendinous fibrosis in group I (a) and significant fibrosis in group II (b)
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